Bronson Methodist Hospital

All Charges

Charge

Type

Setting

Price

PR PRTL EXC B1 TARSAL/METAR B1 XCP TALUS/CALCANEUS

Professional

Both

$1,221.00

Service Code	HCPCS 28122
Min. Negotiated Rate	$283.29
Max. Negotiated Rate	$1,020.15
Rate for Payer: Aetna Commercial	$578.62
Rate for Payer: BCBS Complete	$297.45
Rate for Payer: BCBS Trust/PPO	$1,020.15
Rate for Payer: Cash Price	$976.80
Rate for Payer: Cash Price	$976.80
Rate for Payer: Meridian Medicaid	$297.45
Rate for Payer: Priority Health Choice Medicaid	$283.29
Rate for Payer: Priority Health Cigna Priority Health	$854.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$666.91
Rate for Payer: Priority Health Narrow Network	$666.91
Rate for Payer: Priority Health SBD	$666.91
Rate for Payer: UMR Bronson Commercial	$561.66

PR PRTL EXC BONE FEMUR PROX TIBIA&/FIBULA

Professional

Both

$3,238.00

Service Code	HCPCS 27360
Min. Negotiated Rate	$583.19
Max. Negotiated Rate	$2,266.60
Rate for Payer: Aetna Commercial	$1,194.20
Rate for Payer: BCBS Complete	$612.35
Rate for Payer: BCBS Trust/PPO	$1,958.41
Rate for Payer: Cash Price	$2,590.40
Rate for Payer: Cash Price	$2,590.40
Rate for Payer: Meridian Medicaid	$612.35
Rate for Payer: Priority Health Choice Medicaid	$583.19
Rate for Payer: Priority Health Cigna Priority Health	$2,266.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,391.53
Rate for Payer: Priority Health Narrow Network	$1,391.53
Rate for Payer: Priority Health SBD	$1,391.53
Rate for Payer: UMR Bronson Commercial	$1,489.48

PR PRTL EXC PST VRT INTRNSC B1Y LES 1 VRT SGM CRV

Professional

Both

$1,735.00

Service Code	HCPCS 22100
Min. Negotiated Rate	$617.06
Max. Negotiated Rate	$22,818.32
Rate for Payer: Aetna Commercial	$1,149.22
Rate for Payer: BCBS Complete	$647.91
Rate for Payer: BCBS Trust/PPO	$22,818.32
Rate for Payer: Cash Price	$1,388.00
Rate for Payer: Cash Price	$1,388.00
Rate for Payer: Meridian Medicaid	$647.91
Rate for Payer: Priority Health Choice Medicaid	$617.06
Rate for Payer: Priority Health Cigna Priority Health	$1,214.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,327.18
Rate for Payer: Priority Health Narrow Network	$1,327.18
Rate for Payer: Priority Health SBD	$1,327.18
Rate for Payer: UMR Bronson Commercial	$798.10

PR PRTL EXC PST VRT INTRNSC B1Y LES 1 VRT SGM EA

Professional

Both

$643.00

Service Code	HCPCS 22103
Min. Negotiated Rate	$85.41
Max. Negotiated Rate	$18,089.98
Rate for Payer: Aetna Commercial	$190.38
Rate for Payer: BCBS Complete	$89.68
Rate for Payer: BCBS Trust/PPO	$18,089.98
Rate for Payer: Cash Price	$514.40
Rate for Payer: Cash Price	$514.40
Rate for Payer: Meridian Medicaid	$89.68
Rate for Payer: Priority Health Choice Medicaid	$85.41
Rate for Payer: Priority Health Cigna Priority Health	$450.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$205.29
Rate for Payer: Priority Health Narrow Network	$205.29
Rate for Payer: Priority Health SBD	$205.29
Rate for Payer: UMR Bronson Commercial	$295.78

PR PRTL EXC PST VRT INTRNSC B1Y LES 1 VRT SGM LMBR

Professional

Both

$2,157.00

Service Code	HCPCS 22102
Min. Negotiated Rate	$497.57
Max. Negotiated Rate	$18,089.98
Rate for Payer: Aetna Commercial	$1,102.33
Rate for Payer: BCBS Complete	$522.45
Rate for Payer: BCBS Trust/PPO	$18,089.98
Rate for Payer: Cash Price	$1,725.60
Rate for Payer: Cash Price	$1,725.60
Rate for Payer: Meridian Medicaid	$522.45
Rate for Payer: Priority Health Choice Medicaid	$497.57
Rate for Payer: Priority Health Cigna Priority Health	$1,509.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,192.87
Rate for Payer: Priority Health Narrow Network	$1,192.87
Rate for Payer: Priority Health SBD	$1,192.87
Rate for Payer: UMR Bronson Commercial	$992.22

PR PRTL EXC PST VRT INTRNSC B1Y LES 1 VRT SGM THRC

Professional

Both

$2,225.00

Service Code	HCPCS 22101
Min. Negotiated Rate	$116.11
Max. Negotiated Rate	$1,557.50
Rate for Payer: Aetna Commercial	$1,154.53
Rate for Payer: BCBS Complete	$597.60
Rate for Payer: BCBS Trust/PPO	$116.11
Rate for Payer: Cash Price	$1,780.00
Rate for Payer: Cash Price	$1,780.00
Rate for Payer: Meridian Medicaid	$597.60
Rate for Payer: Priority Health Choice Medicaid	$569.14
Rate for Payer: Priority Health Cigna Priority Health	$1,557.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,336.89
Rate for Payer: Priority Health Narrow Network	$1,336.89
Rate for Payer: Priority Health SBD	$1,336.89
Rate for Payer: UMR Bronson Commercial	$1,023.50

PR PRTL EXC VRT BDY B1Y LES W/O SPI CORD 1 SGM CRV

Professional

Both

$3,200.00

Service Code	HCPCS 22110
Min. Negotiated Rate	$687.35
Max. Negotiated Rate	$18,089.98
Rate for Payer: Aetna Commercial	$1,399.72
Rate for Payer: BCBS Complete	$721.72
Rate for Payer: BCBS Trust/PPO	$18,089.98
Rate for Payer: Cash Price	$2,560.00
Rate for Payer: Cash Price	$2,560.00
Rate for Payer: Meridian Medicaid	$721.72
Rate for Payer: Priority Health Choice Medicaid	$687.35
Rate for Payer: Priority Health Cigna Priority Health	$2,240.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,634.08
Rate for Payer: Priority Health Narrow Network	$1,634.08
Rate for Payer: Priority Health SBD	$1,634.08
Rate for Payer: UMR Bronson Commercial	$1,472.00

PR PRTL EXC VRT BDY B1Y LES W/O SPI CORD 1 SGM EA

Professional

Both

$787.00

Service Code	HCPCS 22116
Min. Negotiated Rate	$89.67
Max. Negotiated Rate	$4,702.18
Rate for Payer: Aetna Commercial	$190.52
Rate for Payer: BCBS Complete	$94.15
Rate for Payer: BCBS Trust/PPO	$4,702.18
Rate for Payer: Cash Price	$629.60
Rate for Payer: Cash Price	$629.60
Rate for Payer: Meridian Medicaid	$94.15
Rate for Payer: Priority Health Choice Medicaid	$89.67
Rate for Payer: Priority Health Cigna Priority Health	$550.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$214.48
Rate for Payer: Priority Health Narrow Network	$214.48
Rate for Payer: Priority Health SBD	$214.48
Rate for Payer: UMR Bronson Commercial	$362.02

PR PRTL HYMENECTOMY/REVJ HYMENAL RING

Professional

Both

$644.00

Service Code	HCPCS 56700
Min. Negotiated Rate	$131.00
Max. Negotiated Rate	$2,047.16
Rate for Payer: Aetna Commercial	$238.45
Rate for Payer: BCBS Complete	$137.55
Rate for Payer: BCBS Trust/PPO	$2,047.16
Rate for Payer: Cash Price	$515.20
Rate for Payer: Cash Price	$515.20
Rate for Payer: Meridian Medicaid	$137.55
Rate for Payer: Priority Health Choice Medicaid	$131.00
Rate for Payer: Priority Health Cigna Priority Health	$450.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$290.21
Rate for Payer: Priority Health Narrow Network	$290.21
Rate for Payer: Priority Health SBD	$290.21
Rate for Payer: UMR Bronson Commercial	$296.24

PR PRTL THYROID LOBECTOMY UNI W/WO ISTHMUSECTOMY

Professional

Both

$3,890.00

Service Code	HCPCS 60210
Min. Negotiated Rate	$259.40
Max. Negotiated Rate	$2,723.00
Rate for Payer: Aetna Commercial	$910.33
Rate for Payer: BCBS Complete	$477.05
Rate for Payer: BCBS Trust/PPO	$259.40
Rate for Payer: Cash Price	$3,112.00
Rate for Payer: Cash Price	$3,112.00
Rate for Payer: Meridian Medicaid	$477.05
Rate for Payer: Priority Health Choice Medicaid	$454.33
Rate for Payer: Priority Health Cigna Priority Health	$2,723.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,003.54
Rate for Payer: Priority Health Narrow Network	$1,003.54
Rate for Payer: Priority Health SBD	$1,003.54
Rate for Payer: UMR Bronson Commercial	$1,789.40

PR PRTL THYROID LOBEC UNI W/CONTRATLAT STOT LOBEC

Professional

Both

$1,795.00

Service Code	HCPCS 60212
Min. Negotiated Rate	$368.75
Max. Negotiated Rate	$1,453.96
Rate for Payer: Aetna Commercial	$1,335.39
Rate for Payer: BCBS Complete	$690.41
Rate for Payer: BCBS Trust/PPO	$368.75
Rate for Payer: Cash Price	$1,436.00
Rate for Payer: Cash Price	$1,436.00
Rate for Payer: Meridian Medicaid	$690.41
Rate for Payer: Priority Health Choice Medicaid	$657.53
Rate for Payer: Priority Health Cigna Priority Health	$1,256.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,453.96
Rate for Payer: Priority Health Narrow Network	$1,453.96
Rate for Payer: Priority Health SBD	$1,453.96
Rate for Payer: UMR Bronson Commercial	$825.70

PR PSA, TOTAL SCREENING

Professional

Both

$60.00

Service Code	HCPCS G0103
Min. Negotiated Rate	$18.34
Max. Negotiated Rate	$1,566.94
Rate for Payer: Aetna Commercial	$18.34
Rate for Payer: BCBS Complete	$24.00
Rate for Payer: BCBS Trust/PPO	$1,566.94
Rate for Payer: Cash Price	$48.00
Rate for Payer: Cash Price	$48.00
Rate for Payer: Priority Health Cigna Priority Health	$42.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$20.04
Rate for Payer: Priority Health Narrow Network	$20.04
Rate for Payer: Priority Health SBD	$20.04
Rate for Payer: UMR Bronson Commercial	$27.60

PR PSYCHIATRIC DIAGNOSTIC EVALUATION

Professional

Both

$260.00

Service Code	HCPCS 90791
Min. Negotiated Rate	$94.36
Max. Negotiated Rate	$203.40
Rate for Payer: Aetna Commercial	$149.76
Rate for Payer: BCBS Complete	$99.08
Rate for Payer: BCBS Trust/PPO	$203.40
Rate for Payer: Cash Price	$208.00
Rate for Payer: Cash Price	$208.00
Rate for Payer: Meridian Medicaid	$99.08
Rate for Payer: Priority Health Choice Medicaid	$94.36
Rate for Payer: Priority Health Cigna Priority Health	$182.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$170.53
Rate for Payer: Priority Health Narrow Network	$170.53
Rate for Payer: Priority Health SBD	$159.98
Rate for Payer: UMR Bronson Commercial	$119.60

PR PSYCHIATRIC DIAGNOSTIC EVAL W/MEDICAL SERVICES

Professional

Both

$259.00

Service Code	HCPCS 90792
Min. Negotiated Rate	$108.20
Max. Negotiated Rate	$181.30
Rate for Payer: Aetna Commercial	$163.88
Rate for Payer: BCBS Complete	$113.61
Rate for Payer: BCBS Trust/PPO	$140.00
Rate for Payer: Cash Price	$207.20
Rate for Payer: Cash Price	$207.20
Rate for Payer: Meridian Medicaid	$113.61
Rate for Payer: Priority Health Choice Medicaid	$108.20
Rate for Payer: Priority Health Cigna Priority Health	$181.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$165.10
Rate for Payer: Priority Health Narrow Network	$165.10
Rate for Payer: Priority Health SBD	$165.10
Rate for Payer: UMR Bronson Commercial	$119.14

PR PSYCHOANALYSIS

Professional

Both

$197.00

Service Code	HCPCS 90845
Min. Negotiated Rate	$78.80
Max. Negotiated Rate	$353.96
Rate for Payer: Aetna Commercial	$96.55
Rate for Payer: BCBS Complete	$78.80
Rate for Payer: BCBS Trust/PPO	$353.96
Rate for Payer: Cash Price	$157.60
Rate for Payer: Cash Price	$157.60
Rate for Payer: Priority Health Cigna Priority Health	$137.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$103.24
Rate for Payer: Priority Health Narrow Network	$103.24
Rate for Payer: Priority Health SBD	$103.24
Rate for Payer: UMR Bronson Commercial	$90.62

PR PSYCHOLOGICAL TST EVAL SVC PHYS/QHP EA ADDL HOUR

Professional

Both

$178.00

Service Code	HCPCS 96131
Min. Negotiated Rate	$47.93
Max. Negotiated Rate	$1,854.86
Rate for Payer: Aetna Commercial	$90.37
Rate for Payer: BCBS Complete	$50.33
Rate for Payer: BCBS Trust/PPO	$1,854.86
Rate for Payer: Cash Price	$142.40
Rate for Payer: Cash Price	$142.40
Rate for Payer: Meridian Medicaid	$50.33
Rate for Payer: Priority Health Choice Medicaid	$47.93
Rate for Payer: Priority Health Cigna Priority Health	$124.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$101.51
Rate for Payer: Priority Health Narrow Network	$101.51
Rate for Payer: Priority Health SBD	$101.51
Rate for Payer: UMR Bronson Commercial	$81.88

PR PSYCHOLOGICAL TST EVAL SVC PHYS/QHP FIRST HOUR

Professional

Both

$234.00

Service Code	HCPCS 96130
Min. Negotiated Rate	$69.23
Max. Negotiated Rate	$1,286.94
Rate for Payer: Aetna Commercial	$119.92
Rate for Payer: BCBS Complete	$72.69
Rate for Payer: BCBS Trust/PPO	$1,286.94
Rate for Payer: Cash Price	$187.20
Rate for Payer: Cash Price	$187.20
Rate for Payer: Meridian Medicaid	$72.69
Rate for Payer: Priority Health Choice Medicaid	$69.23
Rate for Payer: Priority Health Cigna Priority Health	$163.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$144.18
Rate for Payer: Priority Health Narrow Network	$144.18
Rate for Payer: Priority Health SBD	$144.18
Rate for Payer: UMR Bronson Commercial	$107.64

PR PSYCHOLOGIC TESTING ADMIN BY COMPUTER

Professional

Both

$54.00

Service Code	HCPCS 96103
Min. Negotiated Rate	$21.60
Max. Negotiated Rate	$37.80
Rate for Payer: BCBS Complete	$21.60
Rate for Payer: Cash Price	$43.20
Rate for Payer: Priority Health Cigna Priority Health	$37.80
Rate for Payer: UMR Bronson Commercial	$24.84

PR PSYCHOLOGIC TESTING BY PSYCH/PHYS

Professional

Both

$146.00

Service Code	HCPCS 96101
Min. Negotiated Rate	$58.40
Max. Negotiated Rate	$102.20
Rate for Payer: BCBS Complete	$58.40
Rate for Payer: Cash Price	$116.80
Rate for Payer: Priority Health Cigna Priority Health	$102.20
Rate for Payer: UMR Bronson Commercial	$67.16

PR PSYCHOTHERAPY COMPLEX INTERACTIVE

Professional

Both

$141.00

Service Code	HCPCS 90785
Min. Negotiated Rate	$6.51
Max. Negotiated Rate	$294.26
Rate for Payer: Aetna Commercial	$15.85
Rate for Payer: BCBS Complete	$8.73
Rate for Payer: BCBS Trust/PPO	$294.26
Rate for Payer: Cash Price	$112.80
Rate for Payer: Cash Price	$112.80
Rate for Payer: Meridian Medicaid	$8.73
Rate for Payer: Priority Health Choice Medicaid	$8.31
Rate for Payer: Priority Health Cigna Priority Health	$98.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$6.51
Rate for Payer: Priority Health Narrow Network	$6.51
Rate for Payer: Priority Health SBD	$6.51
Rate for Payer: UMR Bronson Commercial	$64.86

PR PSYCHOTHERAPY FOR CRISIS EACH ADDL 30 MINUTES

Professional

Both

$116.00

Service Code	HCPCS 90840
Min. Negotiated Rate	$41.32
Max. Negotiated Rate	$660.38
Rate for Payer: Aetna Commercial	$74.88
Rate for Payer: BCBS Complete	$43.39
Rate for Payer: BCBS Trust/PPO	$660.38
Rate for Payer: Cash Price	$92.80
Rate for Payer: Cash Price	$92.80
Rate for Payer: Meridian Medicaid	$43.39
Rate for Payer: Priority Health Choice Medicaid	$41.32
Rate for Payer: Priority Health Cigna Priority Health	$81.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$56.28
Rate for Payer: Priority Health Narrow Network	$56.28
Rate for Payer: Priority Health SBD	$56.28
Rate for Payer: UMR Bronson Commercial	$53.36

PR PSYCHOTHERAPY FOR CRISIS INITIAL 60 MINUTES

Professional

Both

$225.00

Service Code	HCPCS 90839
Min. Negotiated Rate	$82.43
Max. Negotiated Rate	$311.17
Rate for Payer: Aetna Commercial	$150.80
Rate for Payer: BCBS Complete	$86.55
Rate for Payer: BCBS Trust/PPO	$311.17
Rate for Payer: Cash Price	$180.00
Rate for Payer: Cash Price	$180.00
Rate for Payer: Meridian Medicaid	$86.55
Rate for Payer: Priority Health Choice Medicaid	$82.43
Rate for Payer: Priority Health Cigna Priority Health	$157.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$158.13
Rate for Payer: Priority Health Narrow Network	$158.13
Rate for Payer: Priority Health SBD	$158.13
Rate for Payer: UMR Bronson Commercial	$103.50

PR PSYCHOTHERAPY W/PATIENT 30 MINUTES

Professional

Both

$109.00

Service Code	HCPCS 90832
Min. Negotiated Rate	$43.67
Max. Negotiated Rate	$1,348.22
Rate for Payer: Aetna Commercial	$72.80
Rate for Payer: BCBS Complete	$45.85
Rate for Payer: BCBS Trust/PPO	$1,348.22
Rate for Payer: Cash Price	$87.20
Rate for Payer: Cash Price	$87.20
Rate for Payer: Meridian Medicaid	$45.85
Rate for Payer: Priority Health Choice Medicaid	$43.67
Rate for Payer: Priority Health Cigna Priority Health	$76.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$105.08
Rate for Payer: Priority Health Narrow Network	$105.08
Rate for Payer: Priority Health SBD	$66.97
Rate for Payer: UMR Bronson Commercial	$50.14

PR PSYCHOTHERAPY W/PATIENT 45 MINUTES

Professional

Both

$167.00

Service Code	HCPCS 90834
Min. Negotiated Rate	$57.72
Max. Negotiated Rate	$300.07
Rate for Payer: Aetna Commercial	$114.40
Rate for Payer: BCBS Complete	$60.61
Rate for Payer: BCBS Trust/PPO	$300.07
Rate for Payer: Cash Price	$133.60
Rate for Payer: Cash Price	$133.60
Rate for Payer: Meridian Medicaid	$60.61
Rate for Payer: Priority Health Choice Medicaid	$57.72
Rate for Payer: Priority Health Cigna Priority Health	$116.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$137.66
Rate for Payer: Priority Health Narrow Network	$137.66
Rate for Payer: Priority Health SBD	$103.96
Rate for Payer: UMR Bronson Commercial	$76.82

PR PSYCHOTHERAPY W/PATIENT 60 MINUTES

Professional

Both

$233.00

Service Code	HCPCS 90837
Min. Negotiated Rate	$85.20
Max. Negotiated Rate	$286.87
Rate for Payer: Aetna Commercial	$168.48
Rate for Payer: BCBS Complete	$89.46
Rate for Payer: BCBS Trust/PPO	$286.87
Rate for Payer: Cash Price	$186.40
Rate for Payer: Cash Price	$186.40
Rate for Payer: Meridian Medicaid	$89.46
Rate for Payer: Priority Health Choice Medicaid	$85.20
Rate for Payer: Priority Health Cigna Priority Health	$163.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$172.34
Rate for Payer: Priority Health Narrow Network	$172.34
Rate for Payer: Priority Health SBD	$151.60
Rate for Payer: UMR Bronson Commercial	$107.18

Know your out-of-pocket cost for care.

All Charges